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OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
TM
Enumerator Continuation Questionnaire
FOR NPC
USE ONLY
ACO
State
Tract
➤
➤
APPLY LABEL HERE
Block
ns
h
Map Spot
County
ip
Enter ID Number from Barcode Label on the D-Q-UE for this household.
of
questionnaire(s)
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C
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Questionnaire
ft:
CONTINUATION QUESTIONNAIRE FOR
D
ra
ENUMERATOR QUESTIONNAIRES
FORM
D-CQ-UE (02-05-2019) Draft 9
11870011
§,x!>¤
1.
What is the name of
Person
?
7.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
At a seasonal or
second residence
No
In a nursing home
Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K
Vietnamese
ze
Chinese
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
iti
Opposite-sex husband/wife/spouse
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
o
Is this person male or female? Mark K
J ONE box.
I
Female
N
Male
What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Age on April 1, 2020
Year of birth
ra
years
Print numbers in boxes.
Month
Day
ft:
5.
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
For another reason
For a job or business
4.
ip
In a jail or prison
For college
ns
h
With a parent or other relative
For a military assignment
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K
C
2.
6.
D
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.
2
11870029
§,x!F¤
1.
What is the name of
Person
?
7.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
At a seasonal or
second residence
No
Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K
Chinese
Vietnamese
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
ze
In a nursing home
Opposite-sex husband/wife/spouse
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
o
Is this person male or female? Mark K
J ONE box.
I
Female
N
Male
What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
ft:
5.
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
For another reason
For a job or business
4.
ip
In a jail or prison
For college
ns
h
With a parent or other relative
For a military assignment
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K
iti
2.
Age on April 1, 2020
Year of birth
ra
years
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
D
6.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.
3
11870037
§,x!N¤
1.
What is the name of
Person
?
7.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
At a seasonal or
second residence
No
In a nursing home
Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K
Vietnamese
ze
Chinese
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
iti
Opposite-sex husband/wife/spouse
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
o
Is this person male or female? Mark K
J ONE box.
I
Female
N
Male
What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Age on April 1, 2020
Year of birth
ra
years
Print numbers in boxes.
Month
Day
ft:
5.
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
For another reason
For a job or business
4.
ip
In a jail or prison
For college
ns
h
With a parent or other relative
For a military assignment
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K
C
2.
6.
D
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.
4
11870045
§,x!U¤
1.
What is the name of
Person
?
7.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
At a seasonal or
second residence
No
Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K
Chinese
Vietnamese
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
ze
In a nursing home
Opposite-sex husband/wife/spouse
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
o
Is this person male or female? Mark K
J ONE box.
I
Female
N
Male
What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
ft:
5.
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
For another reason
For a job or business
4.
ip
In a jail or prison
For college
ns
h
With a parent or other relative
For a military assignment
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K
iti
2.
Age on April 1, 2020
Year of birth
ra
years
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
D
6.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.
5
11870052
§,x!]¤
1.
What is the name of
Person
?
7.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
At a seasonal or
second residence
No
In a nursing home
Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K
Vietnamese
ze
Chinese
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
iti
Opposite-sex husband/wife/spouse
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
o
Is this person male or female? Mark K
J ONE box.
I
Female
N
Male
What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Age on April 1, 2020
Year of birth
ra
years
Print numbers in boxes.
Month
Day
ft:
5.
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
For another reason
For a job or business
4.
ip
In a jail or prison
For college
ns
h
With a parent or other relative
For a military assignment
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K
C
2.
6.
D
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If more people were counted in Question S6 on the
D-Q-UE, continue with the next person on the next
page.
6
11870060
§,x!o¤
1.
What is the name of
Person
?
7.
Print name below and verify the spelling.
First Name
MI
Please read the RACE section on the Information Sheet.
What is this person’s race?
Mark K
J one or more boxes AND print origins.
I
White – Print, for example, German, Irish, English, Italian,
Lebanese, Egyptian, etc. C
Last Name(s)
At a seasonal or
second residence
No
Please read the RELATIONSHIP section on the Information
Sheet.
J ONE box.
I
How is this person related to Person 1? Mark K
Chinese
Vietnamese
Native Hawaiian
Filipino
Korean
Samoan
Asian Indian
Japanese
Chamorro
ze
In a nursing home
Opposite-sex husband/wife/spouse
Father or mother
Opposite-sex unmarried partner
Grandchild
Same-sex husband/wife/spouse
Parent-in-law
Same-sex unmarried partner
Son-in-law or daughter-in-law
Biological son or daughter
Other relative
Adopted son or daughter
Roommate or housemate
Stepson or stepdaughter
Foster child
Brother or sister
Other nonrelative
Other Asian –
Print, for example,
Pakistani, Cambodian,
Hmong, etc. C
C
Other Pacific Islander –
Print, for example,
Tongan, Fijian,
Marshallese, etc. C
Some other race – Print race or origin. C
o
Is this person male or female? Mark K
J ONE box.
I
Female
N
Male
What is this person’s age on April 1, 2020? What is this
person’s date of birth? If you don’t know the exact age, please
estimate. For babies less than 1 year old, do not report the age in
months. Report 0 as the age.
Print numbers in boxes.
Month
Day
ft:
5.
American Indian or Alaska Native – Print name of enrolled or
principal tribe(s), for example, Navajo Nation, Blackfeet Tribe,
Mayan, Aztec, Native Village of Barrow Inupiat Traditional
Government, Nome Eskimo Community, etc. C
For another reason
For a job or business
4.
ip
In a jail or prison
For college
ns
h
With a parent or other relative
For a military assignment
3.
Black or African Am. – Print, for example, African American,
Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. C
Does this person usually live or stay somewhere else?
For example – Read examples to respondent.
J all that apply.
I
Mark K
iti
2.
Age on April 1, 2020
Year of birth
ra
years
➜ NOTE: Please answer BOTH the question about Hispanic
origin and the question about race. For this census, Hispanic
origin is not a race.
D
6.
Please read the HISPANIC ORIGIN section on the Information
Sheet.
Is this person of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican Am., Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin – Print, for
example, Salvadoran, Dominican, Colombian, Guatemalan,
Spaniard, Ecuadorian, etc. C
➜ If needed, continue with the next person on another
Continuation Questionnaire (D-CQ-UE) and update the
number of continuation questionnaires on page 1 of
both D-Q-UE and D-CQ-UE questionnaires.
7
11870078
§,x!w¤
iti
ze
ns
h
ip
OMB No. xxxx-xxxx: Approval Expires xx/xx/xxxx
D
ra
ft:
N
o
C
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11870086
| File Type | application/pdf |
| File Modified | 2019-02-08 |
| File Created | 2019-01-22 |